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Obstruction of aortocoronary bypass due to blunt chest trauma
Insights
This case study details acute myocardial infarction caused by blunt chest trauma in a patient with a saphenous vein bypass graft. The obstruction occurred at the graft level, leading to anterior descending coronary artery occlusion and a left ventricular aneurysm.
Area of Science:
- Cardiology
- Trauma Surgery
- Vascular Surgery
Background:
- Blunt chest trauma can precipitate acute cardiac events.
- Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
- Complications of CABG can include graft failure and myocardial infarction.
Observation:
- A patient with a history of saphenous vein aortocoronary bypass to the anterior descending coronary artery sustained blunt chest trauma.
- The trauma resulted in acute myocardial infarction.
- Angiography revealed a two-stump appearance (aortic and coronary) of the bypass graft.
Findings:
- The primary obstruction was identified at the graft level, leading to occlusion of the anterior descending coronary artery.
- A large left ventricular aneurysm developed secondary to the myocardial infarction.
- Despite the aneurysm, the patient remained clinically stable.
Implications:
- This case highlights a rare but serious complication of blunt chest trauma in patients with prior CABG.
- It underscores the importance of considering graft integrity in patients presenting with chest trauma and cardiac symptoms.
- Conservative management was successful in this case, with the patient remaining asymptomatic at 15 months post-trauma, suggesting potential for non-surgical approaches in stable patients.
Abstract:
We report the first case in the literature of acute myocardial infarction due to blunt chest trauma in a patient with saphenous vein aortocoronary bypass to the anterior descending coronary artery. Angiograms demonstrated two stumps - aortic and coronary - suggesting that the primary obstruction was at the graft level with subsequent anterior descending occlusion. A large left ventricular aneurysm developed. As his clinical situation was stable, early aneurysmectomy was not done, and the patient is asymptomatic 15 months after the trauma.